Open Versus Laparoscopic Liver Resection for T1 and T2 Hepatocellular Carcinoma: A Midterm Result

Choon Hyuck D Kwon, MD PhD, Sanghyun Song, MD, Jae-won Joh, MD PhD. Samsung Medical Center, Sungkyunkwan University School of Medicine

Introduction: Laparoscopic liver resection (LLR) has gained much popularity in the recent years, and hepatocellular carcinoma (HCC) has increasingly become an indication for LLR. However due to the technical difficulties faced with underlying liver cirrhosis and the fear for increased recurrence, it is performed relatively restrictively. We herein present the midterm results of LLR in HCC performed in our institution and compared its results with those of open resection (OR).
Method: Retrospective analyses of 232 patients with T1 or T2 HCC that receive liver resection (OR 261, LLR 71) from January 2008 until February 2011 were analyzed. Indication for LLR was tumor size less than 5cm except in peripheral protruding masses, and restricted to tumors located at anterolateral segments including both segments 4a and 4b and segment 1. Preclinical data, disease free survival and patient survival was analyzed according to T stage.
Results: More female patients received LLR (25.4% vs. 14.3%, p=0.042). There were more T2 patients in OR (60.9% vs. 36.6%, p=0.001) but background cirrhosis was more frequent in LLR (56.3% vs. 41.6%, p=0.038). In subgroup analysis of T1 (OR 63, LLR 45), estimated blood loss, transfusion rate, preop PIVKA-II, preop WBC was higher, admission days and op time longer and tumor size larger in OR group (p<0.05), but preop AFP, tumor grade, and ICG15min, and safety resection margin was not different. Recurrence free survival (OR 78.5% vs. LLR 80.4%, p=0.67) and patient survival (98.2% vs. 100%, p=0.38) at 3 years were not different. In T2 analysis, OR group had larger tumor size, higher preop AFP and PIVKA-II and longer op time (p<0.05), but the estimated blood loss, transfusion rate, tumor grade, ICG15min and resection margin was not different. Recurrence free survival (OR 64.6% vs. LLR 59.5%, p=0.98) and patient survival (96.3% vs. 83.4%, p=0.13) at 3 years were not different.
Conclusion: Laparoscopic liver resection in HCC with T1 or T2 stage seems to be feasible with equal midterm survival compared to open resection.

Figure: Overall patients survival and recurrence free survival of OR(n=161) and LLR(n=71) does not differ between groups (p=0.60 and 0.39 respectively). The percentage shows the 3 year survival rate.